11521 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No- ----- (Complete in Duplicate) Date Issued 7. 47,Efl Application�is- here ,ew 0 2.qo—1 -7 y made to the San JoaquiA Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION_ 4 I ro�- ------------ Owner's Name__ __1 _ __ ----- -- ------I-------------------- -- --------- -- ------------ -- -- Phone Addrs_� ------ --------------- ---i,.......... S_ - --------------------------- ------------------------- ---------------------------------------------------------------- Contractor's Name---100A_812111061-1----------------I-----------------------------------I---o::------- :------------------------------- Phone Installation will serve: Residence Apartment House [] Commercial E] Trailer Court [:] Motel El Other El Number of living units: 'Number o' El Private bedrooms ___3-_ Number of baths!�Si,� Lot size -----%t_t Wafer Supply: Public sy "E]Community system Private r" Depth to Wafer Table -P—P ft. ,�em ❑ f -IT I Character of soil to a depth of 3 fe" : Sand E]- Gravel E.] —Sandy.-Loarn 1� Clay Loam E) Clay El Adobe E] Hardpan E] Previous Application Made: Yes E]0- W, N.w,&.ns1fru_cf_io`n: Yes � No El FHA/VA':_Yes* No F] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public seweris available within 200 feet.) Septic Tank: Distance from nearest we1___ --------Disfanc rom foundation---- Materia!_-4071 No. of compartments-----A--------------.___Si'e'-_AAI�'It-47--Liquid'de depth----"- I w ----------------Capacify-1102,6_0........ Disposal Field: Distance from neareLf we ------11 47 0 T -------Distance from foundation_ ®________ to nearest lot line___d_7�------ zt Number of lines_-�'-_Z � -_ -_ - Length of each Width of french__1!.V----------------------- Type of filter maieria6�_4'_A4__Depfh of filter maferial ---------------Total length---/19 -------------------------- Distance to nearest T , Seepage Pit: wef�------------------ ---Distance from foundafion----------------- El Number of pits 11 ' " _.Distance to nearest lot line-------------- I-----------------Lining material____ Size. Diameter-----------------------Depth------------------------------- Cesspool: Distance from n earest well----------------Distance from foundat;on--------------------Lining material___----__---_-_-_ ----------I El Size: Diameter----I ---------Depth---------------------------------- -------- ------------------------ ------------------Liquid Capacity---------------------------gal` Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------- ----------- El Distance to nearest lot line_-- ---------------------------------------------------------------- Remodeling and/or repairing (describe]:----------------""---__-"--"_------1------------------------------------------------------------------ ---------------------------------------------------------------L------------------------------------------------------------------------- --- --------------------------------------------------------------------------------------------------------------I----------------------------------------------------------------------------------------------------- ---------------------------------------------------- -------------------------------------------•--------------------------"------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work Will be done in accordance with San Joaquin Count' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. y (Signed)------- -------- 4� f—---------------------------------------------------------------------I-----------------------(Owner and/or Contracforr-_Pp�l By:- ------------------------------------ -------- -----------w (Title)-- (Plot plan, show�ing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR'DEPARTMENT-USE ONLY APPLICATION ACCEPTED BY REVIEWEDBY------------------ -------------------------------------------------------------------------------- ------------------------- DATE ------------ BUILDING PERMIT ISSUED----------------------------------------------------------------- ------------------------------------ DATE --------- ----- ---------------------------- A terations and/or recommendations:-------- I ------------------------------------------------7---------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ----------------------------I------------------------------------------------------------- ------------------------------ ----------------------------------------------------------- ----------------------I-------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------I-------- FINAL INSPECTION BY:-- - - --------------------------- ------------------------- ------ ------------------------ ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streof Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO.